Pelvis, Hips and Groin Injuries

Hydrotherapy For Hips And Knees

A recent review of Literature and research into the effects of Hydrotherapy in Hip and Knee pain found the following:

Hydrotherapy is Beneficial Prior to Surgery

In 2009 Gill et al found that land based and pool based exercise can improve both pain and physical function in patients with OA of the hip or knee.
Those participants who completed the pool based exercise had less pain immediately after the session and the next day, compared to the land based exercise group.
Providing home based exercises outlined by a physiotherapist was found to give further improvement.
This can provide significant benefits for patients who are trying to delay the need for a joint replacement, but also for those awaiting surgery.

Hydrotherapy is Beneficial Immediately after Joint Replacement

In 2009 Rahmann et al identified the benefits of commencing hydrotherapy exercise immediately after hip and knee replacement surgery.
Hydrotherapy assisted joint range of movement, pain and reduced swelling.
It was proposed that this occurred due to changes in the autonomic and circulatory systems when in water.
It was found that specific hydrotherapy exercises guided by a physiotherapist provided better results than increased treatment on the ward or generalised hydrotherapy.
Improved mobility after 14 days was noted in the specific hydrotherapy group compared to the groups who had not received the hydrotherapy program.
No adverse effects were reported throughout the study and appropriate care was taken with all surgical wounds.
The conclusions from the research indicate that patients can gain a significant advantage to their recovery when commencing hydrotherapy after a joint replacement.

Our Physiotherapists would be happy to discuss any of your patients hydrotherapy needs.

It is advised that anyone undertaking a Hydrotherapy program undergo a full assessment prior to commencing in the pool, and receive an individualised program provided by their Physiotherapist.

References:

Gill SD, McBurney H, Schulz DL. Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial. Arch Phys Med Rehabil 2009; 90: 388-394

Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. Arch Phys Med Rehabil 2009; 90: 745 -755.

Women’s Health And Continence

Pelvic floor issues such as leaking urine and pelvic organ prolapse are very common problems affecting the female population, especially those who have had children. Most people are unaware that specialist Physiotherapists can treat these problems, often helping to avoid surgery.

Pregnancy is a time of extreme change and stress in a woman’s body. As the baby grows, the extra weight combined with pregnancy hormones and postural changes, places additional strain on the joints and muscles. As every woman and every pregnancy is different, we offer individual consultations for many of the common complaints of pregnancy, and also in the recovery period after giving birth.

At many Lifecare practices, we have specially trained physiotherapists who can help with Women’s Health, Continence and Pregnancy-related issues such as:

Bladder or bowel incontinence
Having to go to the toilet very frequently or very urgently
Pelvic organ prolapse
Pelvic pain and pain with intercourse
Optimizing the pelvic floor before and/or after surgery eg. Hysterectomy, Prostatectomy
Pregnancy-related pelvic girdle pain or low back pain
Postnatal rectus abdominus diastasis (abdominal muscle separation)

We all want to keep fit and healthy, however if you have pelvic floor dysfunction or are at risk of it (having recently had a baby, or having gone through menopause for example), then not all exercise that is offered at the gym or with a PT is suitable for you.

Physiotherapy4u offers many safe fitness alternatives such as:

Pregnancy education and Pilates courses
Pregnancy pool exercise classes
Mother and baby Pilates classes, including baby massage
Mother and baby pool exercise classes
Clinical Pilates
Aquafit classes for a low impact cardio workout
Individual exercise prescription or one on one Pilates

For more information contact us

Trochanteric Bursitis

WHAT IS IT?

Around your hip joint there are many muscles that help to provide the joint with stability.

Imbalances between the gluteal muscles and another muscle called tensor fascia lata commonly leads to the inflammation of fluid filled sacs (bursa). When the bursa becomes inflamed it can be extremely painful.

WHAT DO I LOOK FOR?

Pain in the outside of the hip and/or buttock region.
Pain when walking, especially up and down stairs.
Inability to lie on your affected side.

WHAT CAUSES IT?

Muscle imbalances around the pelvic/hip region.
Poor control of the pelvic stabilisers.
After an injury such as a fall or a car accident
Pregnancy

WHEN DO I SEE SOMEONE FOR HELP?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.

Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

FOR MORE INFORMATION contact us.

Piriformis Condition

The piriformis muscle is a deep gluteal muscle of the buttock region, and is narrow and pear shaped. The sciatic nerve can pass above, below or through this muscle.

Piriformis Syndrome

Otherwise known as piriformis impingement, this occurs when there is pressure on the sciatic nerve from the muscle. This can present with local and referred pain and abnormal neurological symptoms at the back of the leg, such as pins and needles and numbness, loss of power or strength.

Treatment by a Physiotherapist may consist of stretching and massage. In extreme cases, surgery may be necessary.

Piriformis Strain

This may be acute or chronic and may involve shortening of the muscle. This may present with deep buttock pain that is made worse by sitting or stair climbing. This is also common during pregnancy, when the muscle spasms as the joints in the pelvis become more flexible.

Treatment by a Physiotherapist may include stretching, massage, posture correction, and electrotherapy modalities.

For more information contact us.

Pelvic Organ Prolapse

Usually the bladder, uterus and lower portion of the bowel are well supported in the pelvis. However, if there is a lack of support in the surrounding tissues, one or more of these organs may descend into the vagina, which is known as a Pelvic Organ Prolapse, or simply a Prolapse.

Women may notice vaginal symptoms such as heaviness, a dragging sensation, or a feeling of something bulging down into the vagina. Other signs of a prolapse may be difficulty emptying the bladder or bowels, difficulty using tampons, lower back or abdominal muscle discomfort, or sexual symptoms such as pain, discomfort or loss of sensation.

Prolapse is a more common issue that you may realise – in fact, 50% of women who have given birth will have a prolapse. This risk is increased, but not confined to, those who have had a vaginal birth.

Women who have not had children are not immune to prolapse either – there are many other risk factors. These include women who regularly increase the pressure in their abdomen, such as those suffering from chronic constipation, those who lift heavy weights regularly at work or at the gym, and those who suffer with chronic coughing or sneezing. Other factors contributing to prolapse are ageing and menopause, being overweight, previous pelvic surgery (especially hysterectomy), and whether you have a family history of prolapse.

You will not necessarily require surgery if you have a prolapse.

The majority of prolapses are small enough to trial a period of conservative management before considering surgery. Continence and Women’s Health Physiotherapists have specific qualifications to assess your individual presentation and put in place a management plan. Conservative management involves putting in place strategies to reduce intra abdominal pressure in daily life (for example a safe exercise regime, weight management and correct bladder and bowel emptying techniques), pacing activities throughout the day, and Pelvic Floor Muscle training.

Pelvic Floor Muscle training, when implemented by a physiotherapist with specific qualifications, is recommended as first line therapy for prolapse management, and has been shown to be effective in reducing prolapse symptoms and severity.

If approximately 6 months of well-supervised conservative management is not adequate, then you should be referred to a gynaecologist for further assessment. Surgery, or fitting an internal support device (called a pessary) may be considered at this point. If surgery is required, reducing ongoing intra-abdominal pressure and keeping your Pelvic Floor Muscles functioning well are essential for good long term outcomes.

Pelvic Floor Muscles

The pelvic floor muscles (PFM) are a group of muscles which sit at the base of the pelvis.

These muscles have a role in:

Supporting the abdominal and pelvic organs
Control of the bladder and bowel functions
Control and support of the lumbo-pelvic region in association with the deeper abdominal and back muscles. These groups of muscles, in conjunction with the diaphragm form what is commonly known as ‘the core.’
Sexual function

Most people do not give their PFM a second thought unless their function becomes affected.

Signs that the PFM may not be working well are:

Leakage of urine with a cough, sneeze, laugh, changes in direction or position or with high impact exercises involving bouncing or jumping movements. This is called stress urinary incontinence
Feelings of urgency when needing to go to the toilet, with or without leakage of urine or having to go to the toilet very frequently
Difficulties completely emptying the bladder or bowel
Difficulties holding onto a bowel movement
Feelings of a bulge or lump in the perineum or vagina, or heaviness or dragging in this area which may indicate a pelvic organ prolapse
Internal pelvic pain or painful sexual intercourse

There is thought to be an increased risk of PFM dysfunction with both pregnancy and vaginal delivery, with the risk increasing with each subsequent pregnancy and vaginal delivery. Women may also notice signs and symptoms with the hormonal changes of menopause, or following any gynaecological surgery, while men may first experience problems following prostate surgery.

Other people who are at risk are those who:

Are overweight or obese,
Have a chronic cough,
Regularly strain on the toilet to empty their bowels (particularly those who suffer from constipation)
Regularly perform high impact exercise which involves repetitive jumping orbouncing movements, or very strong abdominal exercises, all of which will cause a significant downward pressure onto the pelvic floor.

If you are performing any types of exercise such as these it is important to know that your PFM are strong enough to withstand the extra strain being put on this region. If they are not you may be at risk of developing PFM problems.

Even Pilates exercises which are too strong, performed incorrectly or are unsuitable may lead to problems. For this reason, it is important that on commencing Pilates, an initial assessment with a Pilates Physiotherapist, involving the use of the real time ultrasound, is performed to ensure appropriate muscle activation.

For more information contact us.

The action of a PFM contraction is a squeeze and lift action around the front and back passages. Often it can be helpful to focus on the action of stopping yourself passing urine or controlling wind. Men may find a contraction easier in standing focusing on the action of lifting the testes up. The muscles should be able to perform a sustained contraction, plus fast contractions in response to sudden increases in intra-abdominal pressure. Also important is the ability of the muscles to relax afterwards.

If you are unsure whether you are activating your PFM correctly, or have difficulty relaxing the muscles after a contraction, or are experiencing any of the above signs or symptoms, then consulting a Physiotherapist with Postgraduate Qualifications in Continence and Women’s Health is recommended. This will ensure a thorough assessment of your problem and then an appropriate management programme can be commenced. This may also include advice on suitable exercises which do not place excessive force on the PFM.

Osteitis Pubis 2

Osteitis Pubis has unfortunately become a much more common injury in Sports People, especially in the late teenage years. Whilst there are often a number of causes, there is usually a significant element of Bone Stress Reaction.

These problems will usually improve with rest, but commonly the pain returns when the player returns to full activity.

Individual assessment of the causes, and specifically tailored exercise programs are the Gold Standard for the management of these injuries.

These problems commonly need the involvement of the Physiotherapist and Sports Medicine Doctor. Some of these injuries may also require surgery.

What is the cause?

The main cause is a build up of stress between your left and right pubic bones causing a stress reaction

This build up of stress can be caused by:

Weakness of your gluteal (bottom) muscles
Overactivity of your groin muscles
Overactivity of your abdominal muscles
Abnormal hip biomechanics

It is also common in sports (eg. AFL, football/soccer) where player kick, and have sudden changes of direction, or favour one side of your body. It has become more common in these sports as they have also involved increased amounts of running.

What will you feel?

This type of injury doesn’t usually get better as you warm up
Often the pain takes a little while to come on, and then it can feel quiet sharp.
Once you cool down it can remain painful.
Your pubic bone may ache for several days and you will be stiff with movement around your pelvis
It is most commonly felt on your pubic bone/groin, but can radiate into your groin muscles and hip on one side.

What should you do initially?

Follow the treatment:

Rest: avoid exercise that will cause more pain
Ice: Every hour for 15-20 minutes on the painful area
Compression: Skins, or a SIJ brace may take some pressure off the pubic bones
Medicine: Anti-inflammatory medication e.g. Nuerofen.

Make an appointment to see a Sports Medicine Doctor or Physiotherapist for management advice.

What type of rehabilitation is best?

There is no one type of rehabilitation is best, however programs usually contain some or all of the following.

Rest or relative rest from sport that makes the pain worse.
A gradual planned return to sport
Strengthening of the gluteal (bottom) and groin muscles
Abdominal control exercises
Cortisone injections
Acupuncture and soft tissue release
Surgical interventions (adductor release, wedge resection)

It depends on many factors such as; what type of sport you play, the severity of your pain, your age, the duration of the symptoms etc.

How long until you return to sport?

This will depend on the severity of your symptoms and your Physiotherapist’s and Sports Doctors recommendations.
This injury rarely gets better by itself with just rest.
In severe cases this can involve up to 12 weeks rest, and then active Physiotherapy and gradual guarded return to sport in 6 months.

Or Surgical intervention – approximately 10 weeks of rest and then strengthening and control exercises for a further 1-2 months before gradual return to sport.

FOR FURTHER INFORMATION contact us.

Osteitis Pubis

Osteitis Pubis or pubic bone stress injury is a condition that predominantly affects the sporting population and can be severely limiting. Where the superior rami of the pelvis connect there is a cartilaginous joint called the pubic symphysis. It is at this site where symptoms of osteitis pubis typically present, however pain can refer to the hip, inner thigh and lower back. There are a number of factors that can impact upon the presentation and rehabilitation involved with this injury, however no ‘gold standard’ has been identified when it comes to prognostic indicators.

People with this condition often rest for a period of time, which alleviates their symptoms but note their pain returns upon resumption of activity. This comes down to the fact that rest has allowed the persons pain and irritation to settle, however the causative factors have not been addressed.

Thorough assessment is required to identify any deficiencies that may be causing an overload of the pubic area. Just like any other injury adequate rehabilitation is required to correct this. Review with a physiotherapist and sports doctor may be required to map out a rehabilitation program to gradually return to sport.

Because groin pain can be complex your physiotherapist may also want to clear other areas such as your lower back and hips as the source of your pain. This may also involve consultation with a sports doctor and/or imaging.

What is the cause?

The cause of this injury is an overload of the pubic symphysis that the body does not adequately adapt to leading to a stress response of the pubic area.

This build up of stress can be caused by:

– Poor lumbo-pelvic control/muscle weakness

– Abdominal muscle overactivity

– Lack of hip range of motion

– Significant increase in exercise/activity (particularly dynamic and agility work)

It is more common in sports (eg. AFL, football/soccer) where players kick on the run, and have sudden changes of direction or favour one side of their body.

What will you feel?

Pain may initially be in the adductor (groin) muscles
Pain is relieved with rest
An increase in pain through the groin area during and after activity
Significant pain the morning after
Inability to reach full pace or kick long distances
Sharp pain with lateral movements

What should you do initially?

Your physiotherapist or sports doctor will dictate initial management. This generally involves a period of rest until your pain settles to a point where rehabilitation can begin. A doctor may prescribe anti-inflammatories and imaging modalities such as MRI may be useful to indicate what stage your condition is at and to exclude other injuries/pathologies.

What type of rehabilitation is best?

Conservative management is the preferred rehabilitation. As mentioned a period of initial rest is required to ensure you are pain free prior to beginning your rehabilitation program. From here a specific program will be required to address the factors that led to overload of the pubic symphysis.

Stage 1:

Address muscle tightness or increased tone using soft tissue massage and dry needling
Stretching program
Strengthening program (generally targeting gluteal and lumbo-pelvic control)

Stage 2:

Functional strength program
Return to run program (target distance followed by intensity)

Stage 3:

Sport specific drills
Dynamic and agility exercises

If rehabilitation fails to progress at any point review with a sports doctor would be advised for further investigation.

How long until you return to sport?

Severity of symptoms and response to rehabilitation will dictate your return to sport. Pain will be your best guide when it comes to this, however full resolution of symptoms may take anywhere from 2-6 months. Pre-season screening has become an integral part of identifying risk factors for ‘OP’ so seeing your Physiotherapist prior to the sporting season is very important.

FOR FURTHER INFORMATION contact us.

Hip Pain In Adolescents And Children

WHAT IS IT?

Hip pain, in children can have a number of causes such as irritable hip, a slipped upper femoral epiphysis (SUFE) or Perthes disease.

Irritable hip, the cause of the pain is unknown and the child grows out of this with skeletal maturity.
Perthes disease is a loss circulation and subsequent erosion of the head of the hip bone (common at 4-10 years old).
A SUFE is where the head thigh bone ‘slips’ down from the neck at the growth plate (common at 12-15 years old).

Both Perthes and a SUFE are quite serious conditions and require Specialist management

WHAT DO I LOOK FOR ?

Loss of movement of the hip joint.
Pain in the groin, buttock of even radiating into the knee region.
Pain with walking, running, squatting, jumping, kneeling and/or kicking Night pain.

WHAT CAUSES IT?

Often unknown.
Trauma.
Overtraining

WHEN DO I SEE SOMEONE FOR HELP?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.

Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

FOR MORE INFORMATION contact us.

Hip Osteoarthritis

WHAT IS IT?

This condition refers to degeneration of the hip joint surfaces and often a loss of space between the hip and pelvic bones.

WHAT DO I LOOK FOR?

Pain and tenderness to touch in the pubic, groin, inner thigh, buttock or lower abdominal region.
Reduction in the range of movement in the hip. Weakness in the surrounding hip muscles.
Pain with walking and may lead to a limp.
History of a previous hip injury/pathology

WHAT CAUSES IT?

General wear and tear to the joint with use over the years
Previous injury to the Hip

WHEN DO I SEE SOMEONE FOR HELP?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.

Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

FOR MORE INFORMATION contact us.

Hip Impingement

The hip joint is formed by the head of the femur (thigh bone) and the acetabulum of the pelvis (a concave dome shaped area in the pelvic bone). The labrum is also involved; it is a rim of cartilage around the acetabulum which deepens the joint to increase stability and ‘suctions’ the femoral head in to seal and protect the joint. The hip joint is a ball and socket type joint, so allows a wide range of movement to occur. It is given stability by muscles and ligaments which surround the joint and tighten at end range of movement.

Femoroacetabular impingement (FAI) occurs when the neck of the femur (the top part of the femur, just below the head) butts up against the acetabular rim, and can be caused by two types of impingement. CAM impingement occurs when there is a structural abnormality of the femur, with excess bone at the femur head-neck junction. Pincer impingement occurs when there is an abnormality of the acetabulum and excess bone. Both cause damage to occur to the labrum (it is a common cause of labral tears) and cartilage of the hip joint.

FAI is a chronic process that causes gradual and progressive degeneration at the area of impingement, and is a common cause of osteoarthritis of the hip. It is very important to seek proper assessment and treatment so that the onset of hip osteoarthritis may be delayed or prevented.

Impingement is most likely to occur when the hip joint is moved into flexion and internal rotation (legs bent up and turned in). Sports involving this hip position may increase the risk of developing FAI, such as hockey, tennis, soccer, water polo and weightlifting. FAI most commonly occurs in young to middle aged adults, with males more commonly affected than females, and often in those who are active in sports.

Signs and symptoms

The primary symptom that people with FAI complain of is gradual onset progressive one sided groin pain, which may be aching, sharp or often both. Pain location is not restricted to the groin however, it may present in other areas around the hip, such as the front or side of the hip. In some cases there may have been a history of minor trauma, but often there is not. The pain is usually intermittent and is worsened by physical activity (often running or pivoting) or prolonged sitting. Pain may be eased by rest and frequent changes of position. X-rays, MRIs or CT scans may be needed to confirm a diagnosis of FAI.

Treatment/management

Physiotherapists can give advice on activity modification, use manual therapy techniques such as joint mobilisations, teach technique alteration for sports and give exercises to ensure muscles around the hip are balanced to alleviate and reduce pain. This may be enough to effectively treat FAI; however some patients may require surgery.

Physiotherapy treatment is always recommended before considering surgery.

Surgery for FAI aims to increase the clearance between the femur and the acetabulum to stop the two structures from continuing to impact other. This in turn stops the damage to the hip from continuing thereby alleviating pain and delaying osteoarthritis.Physiotherapy post-surgery is important for assisting patients in regaining range of movement, mobility and returning to sport.

For more information contact us.

Groin Injuries

Groin injuries frequently occur in sports involving twisting and turning. There are a number of muscles and tendons in the groin area as well as other structures, which can cause groin injuries. Hence, all groin pain is not the same and not treated the same.

COMMON PROBLEMS AND CAUSES

The three muscles on the inside of the upper thigh are named the adductor muscles. Adductor muscle strains are in fact the most common cause of groin pain and normally occur when the athlete changes direction quickly and over-stretches the adductor muscles.

The problem with groin strains is that unless recognition and correct treatment for the causative factor is performed, the athlete may experience further recurrent groin strains. Therefore the all too often scenario of a sports person simply resting and waiting for the muscles to repair and then resuming sport as per normal, may be insufficient to prevent further recurrence unless the predisposing factor is also addressed.

Some of the more common predisposing factors to recurrent groin injury include:

-Inadequate rehabilitation of the initial injury

-Stiffness of the low back

-Poor pelvic stability and muscle imbalances

OTHER CAUSES OF PAIN

-Adductor tendonitis

-Referred pain from the hip

-Referred pain from the back

-Inguinal hernia

-Osteitis pubis (inflammation of the pelvic bone)

-Conjoint tendon injuries.

INTIAL TREATMENT

Immediately after injury treatment of a groin strain involves reducing any bleeding and inflammation. This requires using the RICER regimen, and referral to an appropriate Sports Doctor and Physiotherapist.

WHAT TO DO ?

Treatment to maximise full rehabilitation following groin injury should involve Physiotherapy whereby any causative factors can be properly addressed. Physiotherapists also have methods of reducing inflammation and equipment used to promote healing and full recovery.

“Don’t wait to get better”

FOR MORE INFORMATION contact us.

Footballer’s Groin

WHAT IS IT?

Footballer’s groin usually refers to one of three conditions or a combination of them.

The three conditions are:

Osteitis pubis (OP) Inflamation and sometimes degeneration of the pubic bone.
Inguinal wall hernia is an insufficiciency or teari n the lower abdomen in the conjoint tendon/inguinal region.

Adductor tendinitis is inflammation in the groin muscle (adductors) tendon.

WHAT DO I LOOK FOR?

Pain and tenderness to touch in the pubic, groin, inner thigh or lower abdominal region.
Pain with running, kicking, situps, coughing and/or kicking.
Weakness in the adductor muscles.

WHAT CAUSES IT?

Overtraining.
Reduced pelvic control and imbalances of the pelvic muscles.
Over use of the adductors.
Kicking sports such as football.

WHEN DO I SEE SOMEONE FOR HELP?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan.

Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

FOR MORE INFORMATION contact us.

Femoroacetabular Impingement (FAI)

The hip joint is a ball and socket type joint, so allows a wide range of movement to occur. It is given stability by muscles and ligaments which surround the joint and tighten at end range of movement.

Both cause damage to occur to the labrum (it is a common cause of labral tears) and cartilage of the hip joint. FAI is a chronic process that causes gradual and progressive degeneration at the area of impingement, and is a common cause of osteoarthritis of the hip. It is very important to seek proper assessment and treatment so that the onset of hip osteoarthritis may be delayed or prevented.

Signs and symptoms

Treatment/management

Physiotherapy treatment is always recommended before considering surgery.

Physiotherapy post-surgery is important for assisting patients in regaining range of movement, mobility and returning to sport.

For more information contact us.

Sciatica

“Sciatica” has quickly become a broad term that people use to describe any pain at the back of the thigh and is commonly overused.

Even though pain at the back of thigh can be due to the Sciatic nerve, the reality is that pain in this area is often due to a number of other causes such as pain directly from your back, muscle strain of the glutes or hamstrings and even trigger points or muscle tension.

It is therefore important to have your pain thoroughly assessed, to get the correct diagnosis.

“Sciatica” is symptom caused by irritation of the Sciatic nerve. This irritation can be due to stiffness or inflammation at any point along the nerve’s line. Commonly, the irritation is at the roots of the nerve, as they pass out of the lower back.

Symptoms usually consist of:

Pain along the specific line of the sciatic nerve
Dull, pulling, heaving sensation along that line
Occasionally paraesthesia or a “numb” sensation

Sciatic nerve pain can be diagnosed with specific tests performed by your physiotherapist that assess the nerve’s sensitivity to lengthening and stretching movements. This should be performed in conjunction with a thorough assessment of your lower back and thigh, to formulate a diagnosis as to why you are getting this pain.

Treatment involves treating the area around the nerve to reduce the irritation and reducing the nerve’s sensitivity to stretching. This can involve:

Electrotherapeutic modalities e.g. TENS etc
Specific mobilizations
Dry needling
Specific stretches and exercises
Modifying biomechanics and lifestyle factors

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